age 55 and older represent 22 percent of physicians in practices of two to four physicians and 12 percent of those working in groups of fi ve to nine physicians (Kane, 2004). Going full circle, the selection and adoption of an EHR is greatly infl uenced by the size of the practice. En- terprise EHRs, commonly selected by larger organiza- tions, are expected to meet

the needs of many specialties across an organization. They are known to be less “natural” than those systems designed for a single specialty, and thus they are more diffi cult to adopt.

Understanding the differences in physician and practice characteristics, their impact on adoption, as well as motivating factors that can enhance learning under these same conditions is critical to developing effective training.

E-learning increases productivity Technology has proven highly effective in many indus- tries as a means to facilitate training to drive productivity within an organization. As early as the 1980s, Motorola studied the impact of its Motorola University, fi nding a return on investment of $30 for every dollar invested in training (Brandenberg, 1987). Today, most Fortune 500 companies have sophisticated human-resource applications interfacing with a learning management system (LMS), where managers can enroll and moni- tor employees’ participation in continuing education. Many have taken courses like this, typically in regards to HIPAA compliance or code of ethics within the healthcare fi eld.

The power of technology to infl uence productivity really comes from several core factors: convenience to access, ease of tracking participation and scalability of distribution. Also, taking into account the targeted group of adult learners, power also comes from immediately providing relevance on how the training will benefi t the learner. Threshold time for providing this relevance is even more critical for e-learning. Thus, the full benefi t of technology can only be realized if the online training, or e-learning initiatives, are developed appropriately and take into account the full breadth of variables that can affect learning.

Effective e-learning is customized

EHR training should be relevant to physicians’ spe- cialties. Can you imagine having a neurosurgeon take time from her busy schedule to sit down in front of a computer to complete a training module that references the clinical scenario of a 21-year-old athlete who planted and twisted his right knee, felt a pop and now presents

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with right-knee pain and swelling? Such a situation loses out on the opportunity to grab the learner’s attention by providing immediate relevance. It will also most likely turn the learner off from any additional learning. Now imagine the orthopedic surgeon who operates on 10 knees a day encountering the same scenario. He not only becomes immediately engaged, he begins to activate prior knowledge regarding the care for such a patient. This makes the absorption of new knowledge about the EHR far more effi cient, according to well-established learning theory (such as schema theory). The concept of customization to provide immediate clinical relevance makes perfect sense. However, it wasn’t commonplace among most enterprise-level, multi-specialty organiza- tions incorporating e-learning into their implementation plans because customizing computer-based training for each specialty was complex and cost prohibitive – until recently.

ImplementHIT specializes in e-learning for Allscripts, incorporating the use of patent-pending technology to swap out different clinical scenarios, depending on the specialty of the physicians being trained. Through the use of this advanced online simulation technology, ImplementHIT customizes learning to replicate the EHR exactly as confi gured by the user organization. With highly sophisticated systems, such as the Allscripts Enterprise EHR and its V11 Note module (a problem- based, template-driven documentation tool that renders text via the clicks on a form to capture discrete data), online learning can also provide a means for physicians to learn about clinical content, such as what is available on a form for chest pain, even before going live with the system. This level of customization and simulation makes the transition from training to live environment less stressful for doctors and results in higher levels of adoption.

When appropriately implemented, online learning becomes a scalable tool that allows few to train many. With robust tracking, it can enable an organization to continuously improve, and via convenient, anytime/any- place access, it makes it possible for learners to advance their knowledge of the EHR at their own pace.

The ROI of online EHR training

Using e-learning reduce the amount of training time prior to EHR implementation. This approach keeps physicians in the clinic longer and lessens the impact on their productivity and revenue-generating activities. E-learning for the Allscripts Enterprise EHR produces ROIs of $6 to $10 for every dollar invested in training. More importantly, this drives EHR adop- tion that will result in meaningful use targeted by the HITECH Act, leading to improved patient care and reduced costs.